As in other parts of the body, tumours can also occur in the oral cavity. These neoplasms arise from cells of the oral mucosa, gums, jaw or from cells involved in the development of the teeth. They can be benign or malignant.
The diagnosis is made by means of an x-ray, which shows whether the new formation is solid or cystic. A puncture of the tumour, where cystic fluid is obtained, and a biopsy of the tissue confirm the diagnosis. The differential diagnosis is a normal cyst starting at the tip of the tooth root. Conversely, if a cyst is suspected, an ameloblastoma must also be considered.
What does an ameloblastoma look like in an X-ray?
The ameloblastoma can also be seen in an X-ray image. Since the bone structure is dissolved in this disease, the image shows an altered bone. Normally this appears uniformly white.
Ameloblastoma, on the other hand, develops a “bubble-like” or “honeycomb-like” structure. It could be described as one or more dark spots with a white border, similar to a honeycomb. Usually only a small bone lamella remains. Tooth roots that protrude into it are not displaced. In order to be able to assess the soft tissues, a DVT or a CT must be made.
Histology/fine tissue examination
Although ameloblastoma is by definition a benign neoplasm, it is associated with aggressive growth. This means that it does not displace surrounding structures but destroys them, which is more typical of malignant tumours. There is therefore also a certain risk that the ameloblastoma will change. In about 2% of cases, this new formation malignantly degenerates into a cancer. A histological examination under the microscope is therefore part of the standard treatment in order to rule this out or to detect it early.
Where do ameloblastomas occur more frequently?
There, especially in the area of the molars and in the ascending branch of the lower jaw, i.e. the part between the jaw angle and the joint. In the upper jaw, the front part of the bone is particularly at risk. The therapy consists of the surgical total removal of the entire tumor into the healthy jawbone.
The resulting defect is covered again by bone reconstruction. Unfortunately, ameloblastoma tends to recur, so it can also occur again after surgery. Therefore a control for several years is necessary.
Ameloblast or cyst – How can you tell the difference?
Since ameloblastomas can originate from follicular cysts, a distinction is not so easy. Standard X-rays are often not of sufficient quality to make an accurate diagnosis. On 3-D images, however, more precise information can often be seen.
For example, the cyst is usually only a single chamber. However, the ameloblastoma is “multi-chambered”, which means that there are several chambers separated by bone. In addition, a cyst grows displacing, adjacent structures are pushed to the side, teeth can tip over.
The ameloblastoma, on the other hand, destroys surrounding structures and dissolves them. As far as pain is concerned, the diseases are similar. Both are often recognized as accidental findings, as they usually do not cause any problems.
The definitive diagnosis, however, is made by a histological examination. Under the microscope it can be determined exactly which of the diseases is involved. Ameloblastoma is a mostly benign, painless new formation in the jawbone and therefore causes few symptoms.
It does not form metastases. The diagnosis is made by x-ray, puncture and a test excision. The differential diagnosis is a normal bone cyst. The therapy consists of surgical total removal with controls over several years, so that a recurrence can be detected immediately.